Breaking barriers to rehabilitation: the role of behavior change theories in overcoming the challenge of exercise-related behavior change.

BACKGROUND: Promoting exercise-related behavior change in rehabilitation is a challenge. The lack of integration between rehabilitation program prescriptions, behavior change interventions, and behavioral change theories is profound. Using behavior change theories properly is crucial for better adherence and promoting positive outcomes. Therefore, it is essential to bring theories that support the understanding of exercise-related behavioral change to the attention of rehabilitation practitioners. OBJECTIVE: This masterclass article aims to provide the theoretical background of theories and strategies for exercise behavior change within the physical therapy context based on acknowledged behavioral change theoretical models. METHODS: This is a narrative review that examines six behavior theories; five of them well-established, and a new (and promising) theory that has exhibited the most favorable outcomes in rehabilitation settings. The development process for this masterclass included conversations between authors, reviewing behavior theories, summarizing and discussing the theories' concepts and strategies for physical therapy. RESULTS: The included theories were self-determination theory, social-cognitive theory, the transtheoretical model, the theory of planned behavior, the health belief model, and the unifying theory of physical activity. Each theory offers a unique perspective on exercise behavior change within rehabilitation, exploring constructs such as motivation, self-efficacy, stages of change, behavioral intention, perceived threat, and the core elements of physical activity expression. CONCLUSION: These theoretical models provide a foundation for understanding and developing strategies for promoting exercise behavior change in rehabilitation. Knowing and using these theories is important for respecting the patient's individuality.

U-SMILE: a brief version of the Short Multidimensional Inventory on Lifestyle Evaluation.

INTRODUCTION: Lifestyle Medicine comprises six domains: diet, substance use, physical activity, stress management, social connection, and sleep. The comprehensive assessment of lifestyle is challenging, but the "Short Multidimensional Inventory on Lifestyle Evaluation" (SMILE) was developed to fill out this gap. In this paper, we describe the development and the psychometric properties (internal consistency, concurrent and convergent validity) of a shorter version of the SMILE among university students. METHODS: Data from a cross-sectional study including 369 students from 10 Brazilian universities were used. Considering a theoretical nomological net, we performed exploratory factor analysis to obtain the most parsimonious, interpretable and good-fitting model. RESULTS: The final model was called U-SMILE, comprised 24 items, and presented acceptable internal consistency (Cronbach's α = 0.73, McDonald's ω = 0.79). To evaluate the concurrent validity of the U-SMILE, we compared it to the original SMILE and found a high correlation between the instruments (Spearman's r= 0.94). Furthermore, we evaluated convergent validity by examining the U-SMILE correlation with the PHQ-9 (Spearman's r= -0.517), and GAD-7 (Spearman's r= -0.356), two validated instruments to screen for depression and anxiety, respectively. DISCUSSION: Our findings suggest that the U-SMILE is a valid instrument for assessing lifestyle among university students. We recommend that the use of U-SMILE to evaluate overall lifestyle scores rather than individual domain scores. Finally, we discuss the importance of clarifying the definitions of lifestyle and related constructs in future research.

Clustering of physical activity, sedentary behavior, and diet associated with social isolation among brazilian adolescents.

BACKGOUND: Although obesogenic behaviors have been found to be related to social isolation, evidence-based person-centered approaches are lacking. This study investigated the association between clusters of obesogenic behavior - derived from a data-driven process - and social isolation among Brazilian adolescents. METHODS: Data from the National Adolescent School-based Health Survey (PeNSE) 2015 were analyzed. A total of 100,794 9th-grade students (51.3% females; 14.3 ± 0.1 years old) enrolled in 3,040 public and private high schools participated in the study. Social isolation was assessed by two outcomes (i.e., perceived loneliness and lack of close friends). A two-step cluster analysis was conducted to identify patterns of obesogenic behaviors with the input of leisure-time physical activity (PA), sitting time as a proxy of sedentary behavior (SB), and the weekly consumption of healthy and unhealthy food. Crude and adjusted binary logistic regression models were applied to evaluate the associations between the clusters of obesogenic behaviors and social isolation variables in adolescents. RESULTS: Three clusters were identified. Adolescents in the "Health-promoting SB and diet" (32.6%; OR = 0.69; 95% CI = 0.62-0.76) and "Health-promoting PA and diet" (44.9%; OR = 0.73; 95% CI = 0.67-0.79) clusters had lower odds of loneliness compared to those in the "Health-risk" cluster (22.5%). Those belonging to the "Health-promoting PA and diet" cluster were more likely to report having close friends (OR = 1.19; 95% CI = 1.00-1.41) than those in the "Health-risk" cluster. CONCLUSION: Adolescents in clusters where positive behaviors outweighed negative ones were less likely to perceive themselves as lonely and without close connections.

The relationship between physical activity and depressive symptoms is domain-specific, age-dependent, and non-linear: An analysis of the Brazilian national health survey.

Although there is consistent evidence of the beneficial effects of leisure physical activity (PA) on mental health, the role of PA in the domestic, transport, and occupational domains is inconclusive. This study aimed to analyze the relationship between domain-specific PA and depressive symptoms and examine whether the association is moderated by age in a representative sample of the Brazilian population. Cross-sectional data of 89,923 (52.4% female) individuals aged ≥15 years were analyzed. Depressive symptoms were assessed using the Patient Health Questionnaire-9. Physical activity (min/week) performed in different domains (domestic, transport, occupation, and leisure) was self-reported. Generalized additive models with penalized splines were used to explore associations. Lower leisure-time PA and higher levels of PA in the domestic, occupational, and transport domains at distinct PA thresholds were associated with higher depressive symptoms. Leisure PA, even at lower levels, was associated with lower depressive symptoms compared to no PA at all. The increase in depressive symptoms as a function of occupational PA was observed only at PA levels higher than 40 h/week. Although non-leisure PA levels were related to higher depressive symptoms among the total sample, higher domestic and transport PA levels were related to lower depressive symptoms among older adults. This study provides insights into the non-linearity and age-group dependence of the relationship between domain-specific PA and depressive symptoms in a middle-income country. The evidence suggests that care should be taken on recommending PA regardless of context or domain.

Clustering of Obesogenic Behaviors Associated With Bullying Roles Among 100,794 Adolescents.

Obesogenic behaviors have been individually associated with bullying during adolescence. However, physical activity, sedentary behavior, and diet manifest themselves in synergy and even behavioral profiles in which positive and negative behaviors coexist can be more positively associated with psychosocial outcomes. The present study aimed to analyze the association between clusters of obesogenic behaviors and different bullying roles in Brazilian adolescents. This cross-sectional study used data from the Brazilian School-based Health Survey-PENSE, 2015. A total of 100,794 male and female adolescents of the ninth-grade elementary school participated in the study. Students responded to an electronic questionnaire. Clusters of obesogenic behavior consisted of physical activity, exposure to sedentary behavior, and diet, and the different roles in bullying were: participant, victim, bully, and bully-victim. Binary logistic regression with 95% confidence intervals (CI) was used for data analysis (p < .05). Multiple adjustments and complex sampling procedures were employed. Adolescents in the cluster "Health-promoting sedentary behavior and Diet" had reduced chances of participating in bullying (odds ration [OR] = 0.70; 95% CI [0.64, 0.76]), of being a victim (OR = 0.87; 95% CI = 0.76-0.99), and being the bully (OR = 0.65; 95% CI [0.59, 0.71]); and those from the cluster "Health-promoting physical activity and Diet" had reduced chances of participating (OR = 0.81; 95% CI [0.76, 0.87]), being a victim of bullying (OR = 0.86; 95% CI [0.76, 0.98]), being the bully (OR = 0.79; 95% CI [0.72, 0.85]), and being a bully-victim (OR = 0.74; 95% CI [0.61, 0.90]), when compared to those from the "health-risk" cluster in the adjusted analysis. Clusters of obesogenic behavior may reduce adolescent bullying: victim, bully, and bully-victim benefit when exposed to healthier behavioral profiles. The school setting must recognize bullying as a problem and therefore simultaneously promote multi-component interventions to tackle physical activity, sedentary behavior, and eating behavior. Outcomes other than obesity should be acknowledged when promoting obesogenic behaviors.

An online behavior change intervention to promote physical activity in adults with asthma: study protocol for a multicenter randomized controlled trial.

BACKGROUND: Behavior change interventions have been the focus of recent studies, and the COVID-19 pandemic highlighted the importance of online interventions. However, no previous studies have investigated behavior change techniques to improve physical activity in adults with asthma through online intervention. METHODS: This double-blind clinical trial will investigate the effectiveness of an online behavior change intervention in increasing physical activity and reducing sedentary behavior in adults with asthma, as well as in improving other clinical outcomes in short and medium terms. Patients with clinically stable moderate to severe asthma, who are physically inactive and do not have cardiovascular and/or osteoneuromuscular impairments will be randomized into control or intervention groups (23 in each). Both groups will carry out an online educational program (1 h). Additionally, the intervention group will receive weekly individual online sessions for 12 weeks of motivation-based behavior change intervention to promote an increase in physical activity and reduce sedentary behavior based on both self-determination theory and transtheoretical model. The intervention group will also receive an activity monitor with specific strategies related to it. Both groups will be reassessed immediately after the intervention and 6 months after that. The primary outcomes are physical activity and sedentary behavior, which will be objectively assessed by a triaxial accelerometer (Actigraph wGT3X-BT). Secondary outcomes are Asthma Control Questionnaire, Incremental Step Test, Sit-To-Stand, Timed Up-and-Go, 4-Metre Gait Speed, Asthma Quality of Life Questionnaire, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Actiwatch 2, and the Hospital Anxiety and Depression Scale. DISCUSSION: The intervention is unprecedented and was carefully developed to joint most characteristics and techniques of both behavioral strategies (transtheoretical model and self-determination theory). Therefore, this intervention has the potential to improve physical activity levels and asthma management and reduce sedentary behavior. As a consequence, this novel intervention will improve global health in this population and support its use in clinical practice. The intervention will be carried out online with direct weekly contact with the therapist. Consequently, it has low implementation costs, might improve patient's attendance, and has the potential to be largely offered elsewhere. TRIAL REGISTRATION: ClinicalTrials.gov NCT05241223 . Registered on January 22, 2022.

Physical activity pattern before and during the COVID-19 pandemic and association with contextual variables of the pandemic in adults and older adults in southern Brazil.

Aim: To compare the physical activity pattern before and during the COVID-19 pandemic and verify the association with contextual, behavioral, and health variables related to the pandemic in adults and older adults from southern Brazil. Subject and methods: This is a panel-type, population-based study in Rio Grande-RS and Criciúma-SC, with 4290 individuals. The physical activity pattern (dependent variable) was measured using the International Physical Activity Questionnaire-IPAQ. In addition, contextual, behavioral, and health aspects related to the pandemic (independent variables) were assessed by questionnaires. Fisher's exact test was used for bivariate analyses and Poisson regression with robust variance to calculate crude and adjusted prevalence, with their respective 95% confidence intervals. Results: There was a 72% reduction in commuting physical activity and a 145% increase in physical inactivity when compared before and during the pandemic. Social distancing, excessive search for information about COVID-19, fear of the pandemic, and COVID-19 infection were all factors that contributed to the decline in physical activity during the pandemic. The home office was a protective factor for physical inactivity. Conclusion: The COVID-19 pandemic has negatively affected the pattern of physical activity in the general population, except for those who switched to working from home. Supplementary Information: The online version contains supplementary material available at 10.1007/s10389-022-01789-x.

Techniques to promote motivation for physical activity in the context of primary healthcare / Estratégias para promover motivação para a atividade física no contexto da atenção primária à saúde

Health promotion and physical activity behavior change involve affective and cognitive aspects such as motivation. Thus, greater attention is needed to individuals' motivation to adhere to and maintain physical activity in the Primary Health Care context. This essay aims to present the initial step of a theoretical-methodological intervention model for physical activity behavior change (based on basic psychological needs support) in the Primary Health Care context. The overall research project was organized under three steps: development (discussed in this essay), validation, and evaluation/appli-cation. From the literature analysis, 17 strategies were abducted to promote motivation for physical activity. We offered ways to implement such strategies in the context of Primary Health Care. This work set education to democratize and encourage the appreciation of motivational regulations of physical activity by professionals, researchers, and policymakers interested in health promotion

A promoção da saúde envolve aspectos afetivos e cognitivos para mudanças de comportamento, assim destaca--se a necessidade de maior atenção voltada aos aspectos motivacionais relacionados à adesão e manutenção das pessoas à prática de atividade física no contexto da Atenção Primária à Saúde (APS). Este ensaio tem como objetivo apresentar a etapa inicial de um modelo teórico-metodológico de intervenção para a atividade física no contexto da APS, que considerem os processos regulatórios da motivação. O macroprojeto foi organizado sob três processos: desenvolvimento (foco exclusivo deste ensaio); validação e avaliação/aplicação. A partir da análise bibliográfica foram extraídas 17 estratégias para promover motivação para a atividade física. Após, foi sugerido formas de implementar tais estratégias no contexto da atividade física da APS. Este trabalho visa democratizar e encorajar a apreciação dos aspectos afetivos e cognitivos por profissionais, pesquisadores e gestores interessados na promoção da prática de atividade física para a saúde no contexto da APS.

Techniques to promote motivation for physical activity in the context of primary healthcare / Estratégias para promover motivação para a atividade física no contexto da atenção primária à saúde

Health promotion and physical activity behavior change involve affective and cognitive aspects such as motivation. Thus, greater attention is needed to individuals' motivation to adhere to and maintain physical activity in the Primary Health Care context. This essay aims to present the initial step of a theoretical-methodological intervention model for physical activity behavior change (based on basic psychological needs support) in the Primary Health Care context. The overall research project was organized under three steps: development (discussed in this essay), validation, and evaluation/appli-cation. From the literature analysis, 17 strategies were abducted to promote motivation for physical activity. We offered ways to implement such strategies in the context of Primary Health Care. This work set education to democratize and encourage the appreciation of motivational regulations of physical activity by professionals, researchers, and policymakers interested in health promotion

A promoção da saúde envolve aspectos afetivos e cognitivos para mudanças de comportamento, assim destaca--se a necessidade de maior atenção voltada aos aspectos motivacionais relacionados à adesão e manutenção das pessoas à prática de atividade física no contexto da Atenção Primária à Saúde (APS). Este ensaio tem como objetivo apresentar a etapa inicial de um modelo teórico-metodológico de intervenção para a atividade física no contexto da APS, que considerem os processos regulatórios da motivação. O macroprojeto foi organizado sob três processos: desenvolvimento (foco exclusivo deste ensaio); validação e avaliação/aplicação. A partir da análise bibliográfica foram extraídas 17 estratégias para promover motivação para a atividade física. Após, foi sugerido formas de implementar tais estratégias no contexto da atividade física da APS. Este trabalho visa democratizar e encorajar a apreciação dos aspectos afetivos e cognitivos por profissionais, pesquisadores e gestores interessados na promoção da prática de atividade física para a saúde no contexto da APS

Clustering of Physical Activity, Sleep, Diet, and Screen-Based Device Use Associated with Self-Rated Health in Adolescents.

BACKGROUND: Little is known about how the interplay among health-related behaviors impacts self-rated health (SRH). We examined the clustering of physical activity (PA), sleep, diet, and specific screen-based device use, and the associations between the emergent clusters and SRH among Brazilian adolescents. METHOD: The data used in this cross-sectional study were from the baseline of the Movimente Program. Self-reported data were analyzed. SRH was recorded as a 5-point scale (from poor to excellent). Daily duration of exposure to the computer, the television, the cell phone, and games; PA; sleep; and weekly consumption of fruits and vegetables and ultra-processed foods were included in a Two-Step cluster analysis. Multilevel ordered logistic regressions assessed the associations between the clusters and SRH. RESULTS: The data of 750 students (girls: 52.8%, 13.1 ± 1.0 years) were analyzed. Good SRH was more prevalent (52.8%). Three clusters were identified: the Phubbers (50.53%; characterized by the longest cell phone use duration, shortest gaming and computer use, lowest PA levels, and low consumption of fruits and vegetables), the Gamers (22.80%; longest gaming and computer use duration, PA < sample average, highest intake of ultra-processed foods), and a Healthier cluster (26.67%; physically active, use of all screen-based devices < sample average, and healthier dietary patterns). For both Gamers (-0.85; 95% CI -1.24, -0.46) and Phubbers (-0.71; 95% CI -1.04, -0.38), it was found a decrease in the log-odds of being in a higher SRH category compared with the Healthier cluster. CONCLUSION: Specific clusters represent increased health-related risk. Assuming the interdependence of health-related behaviors is indispensable for accurately managing health promotion actions for distinguishable groups.

Relationship between types of physical activity and depression among 88,522 adults.

BACKGROUND: Physical activity is associated with depression; however, the influence of physical activity type on this association remains poorly explored. We aimed to investigate the association between various types of leisure-time physical activity and depression among a large and representative sample. METHODS: Data from the 2019 Brazilian National Health Survey were used (n = 88,522 adults aged between 18 and 107 years, 53% female). Depression was measured using the Patient Health Questionnaire-9; participants' leisure-time physical activity types were self-reported. A four-step hierarchical regression was applied, and the analyses were adjusted for several confounders. RESULTS: Active individuals had lower odds of depression (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.62-0.81); however, only outdoor walking/running (OR, 0.70; 95% CI, 0.60-0.82), cycling (OR, 0.50; 95% CI, 0.34-0.74), and team sports (OR, 0.52; 95% CI, 0.42-0.66) were associated with lower odds of depression than inactivity. CONCLUSIONS: Physical activity type may be associated with mental health. The qualitative mechanisms of some physical activities seem to have greater capability than others to reduce depression. Causal inferences could not be made, however, our findings suggest that specific physical activities types have additional benefits that can be used in promoting mental health in clinical intervention and at a population level.

Obesogenic Clusters Associated with Weight Status in Brazilian Adolescents of the Movimente School-Base Intervention.

BACKGROUND: the relationship between behavior clusters and weight status, mainly in low- and middle-income countries, remains unclear. This study aimed to examine the association between profiles of physical activity (PA), diet and sedentary behavior (SB) with weight status in adolescents from a southern Brazilian city, according to sex. METHODS: data from the Movimente Intervention study were analyzed (n = 812 / mean age 13.0 years (sd 1.04). Data on SB hours per day, PA minutes per week and weekly consumption frequencies of fruits, vegetables, salty snacks, candies and soda were self-reported on the validated Movimente questionnaire. Classes of healthy and unhealthy behaviors were derived by latent class analysis. Logistic regression analysis was used to estimate the associations between adolescents' weight status and classes. RESULTS: two classes were identified for the whole sample and for boys and girls. All classes had high probabilities of engaging high time in SB. Male adolescents in the unhealthy class had low probabilities of being active and high probability of consuming a low-quality diet. In contrast, girls' healthiest profile presented lower probabilities of being active compared to boys' healthiest profiles. No association was found between weight status and classes. CONCLUSION: All classes had at least one unhealthy behavior, for both the whole sample, and for girls and boys. Girls' profiles were unhealthier compared to boys' profiles. Hence, it is recommended that intervention strategies to change behaviors need to be distinct according to sex, targeting more than one obesogenic behavior at the same time.

Clustering of Physical Activity, Diet and Sedentary Behavior among Youth from Low-, Middle-, and High-Income Countries: A Scoping Review.

BACKGROUND: The interaction between physical activity (PA), diet, and sedentary behavior (SB) plays an important role on health-related outcomes. This scoping review (Prospero CRD42018094826) aims to identify and appraise clusters of PA, diet, and SB among youth (0-19 years) according to country income. METHODS: Five databases were searched. Fifty-seven articles met the inclusion criteria. RESULTS: Fifty-five cluster types were identified, with greater variety in high-income than lower income countries. The most prevalent profiles were "High SB and consumption of sugar, salt, and beverages (SSB)" (n = 17) and "High PA" (n = 13-5), both of which presented in all income countries. The healthiest profile, "High PA and fruit and vegetables (F&V); Low SB and SSB" (n = 12), was present in upper-middle and high-income countries, while the unhealthiest "Low PA and F&V; High SB and SSB" (n = 6) was present only in high-income countries. CONCLUSIONS: High SB and unhealthy diet (SSB) were more prevalent in clusters, mainly in high-income countries. The results support the need for multi-component actions targeting more than one behavior at the same time.

Atividade física para crianças e jovens: Guia de Atividade Física para a População Brasileira / Physical activity for children and youth: Physical Activity Guidelines for the Brazilian Population

A prática regular de atividade física promove benefícios fisiológicos, psicológicos e sociais na vida de crianças e jovens. Apesar da alta prevalência de jovens que não praticam atividade física em nosso país e de termos uma boa colocação no ranking mundial de produção acadêmica sobre pesquisa na área de atividade física e saúde, ainda não havia sido publicadas as recomendações brasileiras de atividade física. O objetivo deste artigo consistiu em descrever como foi desenvolvido o capítulo para crianças e jovens de 6 a 17 anos do Guia de Atividade Física para População Brasileira e apresentar as principais recomendações para esta faixa etária. A construção do capítulo para crianças e jovens envolveu as seguintes etapas: a) revisão de literatura; b) redação da versão preliminar do capítulo; c) processo de escuta com o público alvo referente ao capítulo e especialistas da área de promoção da atividade física; d) realização de consulta pública e; e) redação da versão final do capítulo. Os tópicos apresentados abordam exemplos de atividades físicas praticadas em diferentes domínios; recomendações para a prática (tipos, intensidade, frequência, duração e as formas que a mesma pode ser estruturada). São apresentadas orientações para jovens, pais/responsáveis e professores sobre como adotar e manter um estilo de vida mais ativo fisicamente, assim como sugestões para reduzir o tempo em comportamento sedentário. A elaboração de um guia nacional de atividade física para a população brasileira foi algo inédito, e resultou de um esforço conjunto entre diversos setores da sociedade

Regular physical activity promotes physiological, psychological and social benefits in the lives of children and adolescents. Despite the high prevalence of young people who do not physically activity in our country, and that we have a good ranking in world academic production on research in the physical activity and health area, Brazilian recommendations for physical activity had not been published until then. The aim of this article was to describe how the chapter for children and young people aged 6-17 years of Physical Activity Guidelines for the Brazilian Population was developed and to present the main recommendations for this age group. The construction of the chapter for children and young people involved the following steps: a) lit-erature review; b) writing the preliminary version of the chapter; c) listening process of the target audience for the chapter and specialists in the physical activity promoting area; d) public consultation; and e) writing the final version of the chapter. The topics presented cover examples of physical activities practised in different domains; recommendations for practice (types, intensity, frequency, duration and the ways in which it can be structured). Guidance is provided for young people, parents/guardians and teachers about how to adopt and maintain a more physically active lifestyle, as well as suggestions for reducing time in sedentary behaviour. The construction of a national guidelines about physical activity for Brazilian population is something un-precedented, and resulted from a joint effort of several departments of society

The COVID-19 pandemic challenges physical activity with two emerging paradigms / A pandemia do COVID-19 confronta a atividade física com dois paradigmas emergentes

We are facing an unprecedented crisis due to the COVID-19, with social distancing measures. These measures have adverse impacts and exercise professionals need to gear efforts to promote active lifestyles. This assay has two purposes: 1) To discuss the role of web­based physical activity interventions during and after the COVID-19 pandemic, debating pros and cons, and offering preliminary guidance; 2) To discuss the role of physical activity on mental health, and proposing strategies to exercise interventions. We suggest a more positive outlook to web­based physical activity as internet can expand the scope of exercise as a self-care tool to health enhancement. The use of the internet as a professional tool to support exercise promotion can become a trend. Professional should weigh up the pros and cons when using such approach. After this pandemic we will cherish the psychological well-being benefits of exercise

Estamos enfrentando uma crise sem precedentes em virtude da pandemia de COVID-19 e isso inclui a necessidade de isolamento social. O isolamento social tem efeitos adversos para a saúde mental e manter um estilo de vida ativo é importante. Este ensaio tem como objetivo discutir a atividade física no formato remoto, assim como, a relação da atividade física e saúde mental. São evidenciados prós e contras da atividade física remota através da internet, além de recomendações práticas. Observa-se que a promoção da atividade física remota, utilizando-se da internet, pode ampliar e favorecer o escopo da atividade física para o autocuidado e promoção da saúde. O uso da atividade física remota pode virar uma tendência, contudo, os profissionais devem equilibrar os prós e os contras quando da sua utilização. Evidencia-se que depois da pandemia os benefícios da atividade física sobre a saúde mental serão mais valorizados

Mediating role of screen media use on adolescents' total sleep time: A cluster-randomized controlled trial for physical activity and sedentary behaviour.

BACKGROUND: The present study aimed to analyse the effect of an intervention for increasing physical activity (PA) and reducing sedentary time on adolescents' total sleep time (TST) and to examine whether the effect on adolescents' TST was mediated by the intervention changes on screen-based sedentary time. METHODS: This study was a school-based cluster-randomized controlled trial conducted with Brazilian adolescents in Grades 7 to 9 (in 2017). Three schools participated in each of the intervention group (IG) and control group (CG). The intervention involved the following three strategies designed to increase PA and reduce sedentary time: (a) teacher training, (b) environmental improvements, and (c) health educational component. TST and screen-based sedentary time (television use, cell phone use, playing on computer/video game, and computer use that is not for gaming purposes) on weekdays and weekends were assessed using a standardized questionnaire. Generalized linear mixed models were conducted to verify the effect of the intervention on TST. Mediation analyses were used to examine the mediator role of changes in screen-based sedentary time in the relationship between the intervention and TST. RESULTS: Overall, 597 students participated in this study (mean age: 13.0 ± 1.0 years; IG: n = 351; CG: n = 246). The intervention had no effect on TST on weekdays and weekends. Adolescents in the IG were more likely to report ≤2 hr of television viewing per day on weekdays at follow-up. Mediated effects by screen media use were not significant. CONCLUSIONS: The school-based intervention for increasing PA and reducing sedentary time had no effect on adolescents' TST.

Food consumption and its association with leisure-time physical activity and active commuting in Brazilian workers.

BACKGROUND/OBJECTIVES: An in-depth understanding of the relationship between food consumption and physical activity is relevant since these behaviours could influence each other, while both have an effect on obesity and chronic diseases. In this context, the aim of this study was to investigate the effect of various combinations of food consumption (fruits, vegetables, sweets and snacks) on the associations with PA domains (leisure and commute) among Brazilian industrial workers. SUBJECTS/METHODS: This is part of a cross-sectional national survey developed in Brazil using data from the "Lifestyle and Leisure Habits of Industrial Workers" project. A total of 52,774 workers (response rate: 90.6%) responded to a validated questionnaire about the frequency of their consumption of fruit, vegetables, sweets and snacks, their practice of LTPA and active commuting. The answers were analysed by multilevel regression, controlled by sociodemographic behaviour and the presence of hypertension, diabetes and overweight. RESULTS: Workers with a simultaneously adequate consumption of fruit, vegetables, sweets and snacks were 2.29 (1.74; 2.99 p-value < 0.001) more likely to perform LTPA. In the full model, there was no association among any of the combinations of food consumption and active commuting. CONCLUSION: A better food consumption behaviour was reported among workers who practiced leisure physical activity when compared to those who did not.

Antecedentes motivacionais para a prática de atividade física na atenção primária à saúde / Motivational background for physical activity in primary health care / Antecedentes motivacionales para la práctica de actividad física en la atención primaria de salud

Este estudo objetivou analisar a percepção sobre os antecedentes afetivos para a prática de atividade física (AF) relacionados às necessidades psicológicas básicas (NPB) e investigar as regulações motivacionais para prática de AF no discurso dos participantes iniciantes de um programa de exercício físico na Atenção Primária à Saúde. Trata-se de um estudo transversal de natureza qualitativa com a utilização de Grupo Focal. Participaram da pesquisa 41 adultos. Os resultados demonstram que as percepções dos participantes sugerem frustração para as NPB de autonomia e competência. O comportamento dos participantes para a iniciação ao programa é regulado por contingentes externos, caracterizados por punições e medos na adesão ao programa. Não foram observadas regulações motivacionais intrínsecas, e a autodeterminação para a participação no programa é baixa. Conclui-se que essa população não percebe sentimentos ligados ao prazer pela prática de AF per se, diminuindo as chances de manutenção do comportamento para realizar AF.

This study analyzed the perception about affective background for physical activity (PA) related to basic psychological needs (BPN) and investigated motivational regulations for PA in the discourse of beginners at an exercise program in primary health care. A cross-sectional study was carried out using the Focus Group technique to reach the study's goals. Participants were 41 adult users of Brazil's Unified Health System. Results show that their perceptions suggest frustration regarding basic needs for autonomy and competence. Beginners' behavior is primarily regulated by external circumstances characterized by punishment and fear when joining the program. Intrinsic motivational regulations and low self-determination to participate in the program were not observed. It can be argued that this population does not feel satisfaction and pleasure when doing PA per se, therefore decreasing their chances of maintaining the PA behavior.

Este estudio objetivó analizar la percepción sobre los antecedentes afectivos para la práctica de actividad física (AF) relacionados con las necesidades psicológicas básicas (NPB) e investigar las regulaciones motivacionales para la práctica de AF en el discurso de los participantes que empiezan un programa de ejercicio en la Atención Primaria de Salud. Es un estudio transversal, de naturaleza cualitativa, que utiliza Grupo Focal. Participaron 41 adultos en la investigación. Los resultados demuestran que las percepciones de los participantes sugieren frustración en las NPB de autonomía y competencia. El comportamiento de los participantes al iniciar el programa está reglamentado por contingentes externos, y se caracteriza por castigos y miedos al adherir al programa. No se han observado regulaciones motivacionales intrínsecas y la autodeterminación en la participación en el programa es baja. Se concluye que esta población no percibe sentimientos relacionados con el placer en la práctica de AF en sí, lo que reduce las posibilidades de mantener el comportamiento para realizar AF.